Senior Claims Representative – California Workers Compensation

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Conduct investigations, assessments, and resolutions for lost time and catastrophic workers’ compensation injury claims across various jurisdictions.

• Engage with injured workers, witnesses, and policyholders to confirm coverage and evaluate compensability and benefits owed.

• Calculate and establish timely financial reserves while actively managing reserve adequacy throughout the claims process.

• Document and categorize injured worker demographics, job details, and accident information within the claims management system.

• Submit required forms to state regulatory bodies.

• Ensure prompt payments to injured workers, medical providers, and service vendors.

• Coordinate and manage medical treatment effectively to facilitate timely rehabilitation.

• Negotiate settlements within authorized limits with injured workers and their attorneys.

• Act as a subject matter expert on the Workers’ Compensation Act, adjudication processes, and regulatory compliance standards.

• Identify and oversee subrogation opportunities, Second Injury Fund, and joint coverage recovery initiatives.

• Communicate updates and claim activities to policyholders, injured workers, and other stakeholders.

• Inform management and generate reports for high-exposure claims while adhering to reinsurance reporting obligations.

• Oversee the claims litigation process to ensure timely and cost-effective resolutions.

• Monitor expenses and effectiveness related to managed care and investigation vendors.

• Travel occasionally to attend hearings, conferences, and training sessions.

• Participate in claim file reviews with management and defense attorneys.

• Coordinate and lead special projects or processes as assigned.

• Provide oversight and supervisory support when the team supervisor is unavailable or as directed.

• Assist in training, staff development, and vendor management initiatives.

• Strive for continuous improvement in product and business outcomes through innovative practices.

⛳️ Requirements

• 3 to 5 years of experience in managing workers’ compensation claims.

• Outstanding written and verbal communication abilities.

• Strong interpersonal skills and the ability to build relationships.

• Excellent time management and organizational capabilities.

• Strong analytical and critical thinking aptitude.

• Ability to work independently and solve problems strategically.

• Skillful in managing conflict with diplomacy.

• Capability to cultivate relationships within the organization and collaborate effectively across departments.

• High level of discretion and integrity when handling confidential and sensitive information.

• Detail-oriented with a focus on accuracy.

• Bachelor’s degree or equivalent experience in the insurance industry.

• Preference for candidates with AIC, ARM, CCP, or CPCU insurance designations.

• Must obtain and maintain adjuster license(s) in assigned jurisdictions.

🏝️ Benefits

• Health insurance

• Dental insurance

• Vision insurance

• Life insurance

• Disability insurance

• Wellness benefits

• Paid time off

• 401(k) plan

• Profit-sharing plan

• Competitive compensation plan

• Comprehensive benefits package